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A 74-year-old man presented with a one-year history of diffuse abdominal pain, diarrhea, and weight loss (16 kg [35 lb]). He did not have bone pain. Physical examination revealed no abnormalities except for cachexia; mild, diffuse abdominal distention without tenderness or a palpable mass; and stools that were positive for occult blood on guaiac testing. His blood count was normal except
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